Teaching Digital/E-Professionalism:  Reflections for deepening understanding of professional identity on social media

Nicholas Knowland, TUSM-Maine Track Program, M18

Ensuring the public trust in the medical profession is the reason for promoting professionalism as a key component of medical education. Therefore medical curricula place significant emphasis on the development of professional behaviors.

Digital professionalism, or e-professionalism, describes the increasing interaction of medical professionalism with the greater public through social media outlets. The terms are new but the reality that online images or postings can reflect on students or practitioners has been present for some time and is usually associated with negative connotations.  This has resulted in what some authors have described as a ‘hidden curriculum of digital unprofessionalism’ in which digital unprofessionalism is punished but rarely overtly taught. Despite the consequences that digital unprofessionalism lead to for a clinical student or clinician, the academic literature is increasingly focusing on the positive opportunities associated with professional physician social media use, such as using social media to actively share quality information.

TIP 1:  Consider the Social Media  in Medicine Hierarchy of Needs

There is no clear consensus yet as to what should be taught to instill digital professionalism.  Overt curricula for teaching digital professionalism have recently been developed and are described in one of the references at the bottom of this paper but there is no clear consensus yet as to what digital professionalism really requires.  One useful paradigm is the “Social Media in Medicine Hierarchy of Needs”  to which there are three levels: Security, Reflection and then Discovery.

Discovery: Is the highest level of the pyramid, reached when the lower levels are met. Discovery focuses on how to use social media to benefit patient health, to mentor, and to innovate.

Reflection:  This middle level is where practitioners reflect on their personal online identity and how they want to use social media to interact with colleagues, patients and students.

Security:  This is the bottom level of the pyramid, patients and personal career must be protected from social media consequences or else reflective activities or efforts at discovery will surely be damaging to either the practitioner or their patients.  At a baseline patient privacy must be protected at all times.

In summary, the pyramid is built on:  security for the patients and yourself, reflection on how you want to engage, and discovery of new and evolving opportunities through social media that may prove beneficial to patients or your own career.

Specific questions addressing different aspects of the pyramid include:

Security: Do you know the AMA policy on professional social media use? Your employers?

Reflection:  What do you hope to learn or share?

Reflection:  What are your individual principles?(For example, safeguarding patient privacy is required,  but will you post about patient related experiences in a respectful tone that safeguards anonymity or simply choose not to post about work experiences altogether?)

Reflection:  What will be your personal policy for social media interaction with trainees?  None? Only past trainees? Only for those you are not personally going to evaluate?

Discovery:  How could you use social media to improve healthcare or to disseminate your expertise?

TIP 2:  Google yourself once in a while and see what pops up

Ensure that your professional digital persona is one you want your patients and colleagues seeing

TIP 3:  Reflective questions to propose to your learners

The ubiquity of social media, the lack of consensus exactly defining digital professionalism, the prominence of information sharing among the younger generation and the constant dynamism of social media platforms have made digital professional education difficult to provide.  Nevertheless, some experts at George Washington University Medical School have recently published some questions, used within their own curriculum, that provide good starting points for discussion:

What social media sites do you use most?  What purposes do you visit social media sites for (personal, professional, or both)?

Who are you representing online? Yourself? Your university/employer? Your profession?

How do you define e-professionalism online?

How has your social media identity changed since you entered medical school?

Are there expressions that may seem humorous in person but could appear unprofessional on social media?

If you were to draft a “social media guideline” for the incoming class what would it look like?

TIP 4:  Have examples of positive social media use ready

It is often the case that negative social media experiences or consequences come up in these discussions.  It is important to develop an understanding of these negative consequences to inform the notion of ‘Security’ in the social media hierarchy.

However, there are countless examples of positive social media use. Look at your colleagues’ behaviors or at trainees in other programs and bring those examples with you.  Such positive examples help you and your learners ‘Reflect’ on what positive digital professionalism looks like and how it can benefit the greater public and your own practice.

From there, it is a simple step to start looking towards Discovery.

1: Chretien KC, Kind T. Climbing social media in medicine’s hierarchy of needs.

Acad Med. 2014 Oct;89(10):1318-20. doi: 10.1097/ACM.0000000000000430. PubMed

PMID: 25076202.

2: Gomes AW, Butera G, Chretien KC, Kind T. The Development and Impact of aSocial Media and Professionalism Course for Medical Students. Teach Learn Med.2017 Jul-Sep;29(3):296-303. doi: 10.1080/10401334.2016.1275971. Epub 2017 Mar 8. PubMed PMID: 28272900.

3: Kind T, Patel PD, Lie D, Chretien KC. Twelve tips for using social media as a medical educator. Med Teach. 2014 Apr;36(4):284-90. doi:10.3109/0142159X.2013.852167. Epub 2013 Nov 21. PubMed PMID: 24261897. 4: Ellaway RH, Coral J, Topps D, Topps M. Exploring digital professionalism. Med Teach. 2015;37(9):844-9. doi: 10.3109/0142159X.2015.1044956. Epub 2015 Jun 1.PubMed PMID: 26030375.